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2 things my dad taught me about digital health—and one thing he couldn't

By John League

March 22, 2022

    I have led Advisory Board's research on digital health since before Covid-19 made "digital health" the buzziest of buzzwords. I have had hundreds of conversations with executives, clinicians, vendors, lobbyists, patient advocates, and researchers about digital health topics, including telehealth, reimbursement, physician adoption, consumer experience, digital transformation, artificial intelligence, and what all of that means for the future.

    I've only recently realized that one of my best research contacts for real-world perspective on digital health has been my dad. He turned 70 in 2020, just after Covid-19 took root in the United States, and his experiences of getting care and simply living in a world shaped by digital health have been revealing. Below, I share the two most important things my dad has taught me about digital health—and one important thing that he couldn't.

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    1. Organizations can drive strong patient engagement if they simply provide a unified view of patient care experiences and needs.

    In late 2021, my dad needed transcatheter aortic valve replacement (TAVR). His local cardiologist thought he was a good candidate for the procedure, given his age and overall good health. That said, the TAVR patient journey includes a battery of tests and exams to provide a full picture of the patient's health and heart function to qualify patients for the actual procedure.

    In all, my dad had four pre-op visits, including separate visits each for trans-esophageal echo, CT angiogram, and carotid echo. He also had a whole day of individual labs and exams, which included blood work (they drew seven vials of blood, he tells me), chest X-ray, lung capacity test, and a urine test. And he had four Covid tests at various points in this journey (I should also say that he is fully vaccinated and boosted against Covid).

    Through all of this, the one resource my dad consistently turned to was Epic MyChart. He simply raved about it—which surprised me, honestly. That's not intended as a dig at Epic, it's simply that in conversations I have had with providers and patients, they tend to rate MyChart and most every other kind of integrated portal as "fine." These platforms do many things okay, and some things very well. But to get such a strong review from my not-all-that-tech-savvy dad was unexpected.

    What he appreciated most about it was that he could see everything about his experience in one place: all of his doctors (including his local cardiologist and his surgeon in a different city), all of his appointments, all of his lab and imaging results. He was even able (and willing) to go back to MyChart as I was writing this article to count the number of visits he had and what happened at each one.

    This unified view of his care experience was a real driver of my dad's engagement with the process, and I think it was also a real comfort to him. He knew that there was a single "source of truth" for what he would need to know and what his doctors would see. It didn't matter to him that the user interface that he saw in MyChart on his laptop was not at all slick or particularly intuitive. He was just glad to know where to look when he had a question.

    Digitally enabled care should ideally be an end-to-end experience of health care that incorporates digital resources of technology and data to facilitate proactive and holistic interventions. When we talk about "superlative digital experience" or "frictionless health care," we must remember that what patients want may simply be a single, convenient view of what they need to know and do.

    2. Telehealth really is here to stay.

    When telehealth went from being something most organizations ran as a side hustle to being an essential mode of care delivery in 2020, my team dropped our carefully planned research agenda in favor of an "all telehealth, all the time" approach. Knowing this, my dad also contributed. Every time he saw an article in the newspaper or a magazine, he would clip it out and mail it to me. Every time he got an email from his doctor announcing the availability of virtual visits or providing instruction on how to do one, he forwarded it to me.

    This told me a couple of things. First, many organizations were learning about telehealth in parallel with their patients. That would make for a rough start in many cases, but it also meant that the factors that drove adoption, like ease of use and the ability to build or sustain relationships virtually, would be the same, at least at first, for both patients and providers. Second, it meant that telehealth adoption was being supported by a ton of free media exposure. As that free media has evaporated, it puts the onus on providers and plans to recommend telehealth to patients when appropriate instead of simply offering it.

    Recently, my dad sent me this photo of a sign outside a fast-food chain restaurant in my hometown of Frankfort, Kentucky.

    image

    This sign implies a lot of things about the state of the labor market and benefit design, but it also demonstrates an enormous shift in popular familiarity with digital health. Whomever put up this sign clearly assumes two things about potential fast-food employees in central Kentucky: that they will know what telehealth is, and that they will be attracted by it.

    That potential employee is a different kind of health care consumer than the industry was trying to attract as recently as February 2020, before Covid-19 got to us. This consumer may not even need free media exposure to adopt telehealth as a way to receive care. All this consumer needs might be a clinician who can guide them on when and how to use it well.

    One thing I couldn't learn from my dad

    My dad is a white, cisgender male. He is retired now and on Medicare, but he always had steady employment and affordable access to health care. He has high blood pressure, but that condition has been controlled consistently with medication for most of his adult life.

    He has a home, access to nutritious food (despite an abiding love for M&M's and Diet Coke), and a deep social support network, including my mom, to whom he has been married for 47 years. (Hi, Mom! I wasn't going to leave you out of the article.) He has the means to afford cable TV, a laptop, and an iPhone—and just enough digital literacy to use them to reliably connect to information and other people.

    His experience of health care is common to white, affluent, insured patients, and his experience of digital health is simply an extension of that. Digital health has reduced existing but clearly minor frictions between my dad and health care.

    The digital health imperative I couldn't possibly learn from my dad's experience is how digital inequity manifests in health care. The health care industry is pouring resources into digital health solutions for patients like my dad who already have the lowest risk of chronic disease and the easiest access to care. If health care leaders aren't thinking about how their digital health investments can help mitigate digital inequity, their digital health investments will almost certainly make digital inequity worse.

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